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General NPI Number Information
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NPI Number | 1013674787
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Entity Type | Individual
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Provider Name | KRISTEN COUSINS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 201 N NELLIS BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89110-5321
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Country | US
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Telephone | 702-452-8118
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 N BUFFALO DR APT 1088
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City | LAS VEGAS
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State | NV
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Zip | 89128-0278
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Country | US
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Telephone | 954-805-3378
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21491
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License Number State | NV
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